Provider Demographics
NPI:1104155209
Name:HICKS, RICKELLE ROSE (MA LMFT)
Entity type:Individual
Prefix:
First Name:RICKELLE
Middle Name:ROSE
Last Name:HICKS
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:RICKELLE
Other - Middle Name:ROSE
Other - Last Name:SMYTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 TROYER AVE
Mailing Address - Street 2:
Mailing Address - City:PALISADE
Mailing Address - State:CO
Mailing Address - Zip Code:81526-9749
Mailing Address - Country:US
Mailing Address - Phone:970-778-1584
Mailing Address - Fax:
Practice Address - Street 1:515 28 3/4 RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-5016
Practice Address - Country:US
Practice Address - Phone:970-241-6023
Practice Address - Fax:970-242-8330
Is Sole Proprietor?:No
Enumeration Date:2009-12-18
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO941106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist